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Dorfman DM, Devitt KA, Cui W, Bashleben C, Naharro ECF, Hedley B, Hupp M, Karlon WJ, Murphy CE, Cherian S, Olteanu H, Seifert RP, Rosado FN, Linden MA. PCNEO, a New Proficiency Testing Program for Flow Cytometric Analysis of Plasma Cell Neoplasms From the College of American Pathologists Diagnostic Immunology and Flow Cytometry Committee. Arch Pathol Lab Med 2023:496203. [PMID: 37776247 DOI: 10.5858/arpa.2023-0035-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 10/02/2023]
Abstract
CONTEXT.— In 2018 the College of American Pathologists Diagnostic Immunology and Flow Cytometry Committee designed and implemented a new plasma cell neoplasia flow cytometry proficiency testing program-PCNEO-to allow clinical flow cytometry laboratories to monitor and assess their performance compared with a peer group. OBJECTIVE.— To report the results from the first 4 years of the PCNEO program. DESIGN.— Program participants were sent 2 sets of challenges per year, each including 1 wet challenge and 2 dry challenges, with associated clinical and laboratory findings. The wet challenges were composed of myeloma cell line specimens (with or without dilution in preserved whole blood) for flow cytometric analysis. The dry (paper) challenges were composed of clinical case summaries and images of flow cytometric test results from various flow cytometry laboratories of committee members. RESULTS.— A total of 116 to 145 laboratories from 17 countries enrolled in the proficiency testing program. For the wet challenges, almost all participants (97%-100%; cumulative, 98.2%) correctly identified the presence of neoplastic plasma cell populations based on flow cytometric analysis of undiluted myeloma cell lines. Slightly fewer participants (89.0%-97.4%; cumulative, 95.2%) correctly identified the presence of neoplastic plasma cell populations based on flow cytometric analysis of diluted myeloma cell lines (10% or 50% dilutions into peripheral blood) intended to better represent a typical clinical sample. There was generally agreement among 80% or more of participants for positive or negative staining for CD38, CD138, CD19, CD20, and surface and cytoplasmic κ and λ light chains. Similarly, 84% to 100% of participants were able to correctly identify the presence of neoplastic plasma cell populations in paper challenges, including the presence of small, neoplastic plasma cell populations (0.01%-5.0% clonal plasma cells), or the presence of nonneoplastic plasma cell populations (correctly identified by 91%-96% of participants). CONCLUSIONS.— Participant performance in the new proficiency testing program was excellent overall, with the vast majority of participants able to perform flow cytometric analysis and identify neoplastic plasma cell populations, and to identify small plasma cell clones or expanded populations of reactive plasma cells in dry challenge flow cytometry results. This program will allow laboratories to verify the accuracy of their testing program and test interpretations for the assessment of patients suspected of having a plasma cell neoplasm.
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Affiliation(s)
- David M Dorfman
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Dorfman)
| | - Katherine A Devitt
- The Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington (Devitt)
| | - Wei Cui
- The Department of Pathology and Laboratory Medicine, University of Kansas Health System, Kansas City (Cui)
| | - Christine Bashleben
- Laboratory Improvement Programs, Surveys, College of American Pathologists, Northfield, Illinois (Bashleben)
| | - Elena C Frye Naharro
- The Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis (Naharro, Hupp, Linden)
| | - Benjamin Hedley
- The Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada (Hedley)
| | - Meghan Hupp
- The Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis (Naharro, Hupp, Linden)
| | - William J Karlon
- The Department of Laboratory Medicine, University of California, San Francisco (Karlon)
| | | | - Sindhu Cherian
- The Department of Laboratory Medicine and Pathology, University of Washington, Seattle (Cherian)
| | - Horatiu Olteanu
- The Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Olteanu)
| | - Robert P Seifert
- The Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville (Seifert)
| | - Flavia N Rosado
- The Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Rosado)
| | - Michael A Linden
- The Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis (Naharro, Hupp, Linden)
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2
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Seifert RP, Gorlin DA, Borkowski AA. Artificial Intelligence for Clinical Flow Cytometry. Clin Lab Med 2023; 43:485-505. [PMID: 37481325 DOI: 10.1016/j.cll.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
In this review, the authors discuss the fundamental principles of machine learning. They explore recent studies and approaches in implementing machine learning into flow cytometry workflows. These applications are promising but not without their shortcomings. Explainability may be the biggest barrier to adoption, as they contain "black boxes" in which a complex network of mathematical processes learns features of data that are not translatable into real language. The authors discuss the current limitations of machine learning models and the possibility that, without a multiinstitutional development process, these applications could have poor generalizability. They also discuss widespread deployment of augmented decision-making.
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Affiliation(s)
- Robert P Seifert
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, College of Medicine, 4800 Southwest 35th Drive, Gainesville, FL 32608, USA.
| | - David A Gorlin
- University of Florida, College of Medicine, 1600 Southwest Archer Road, Gainesville, FL 32610, USA
| | - Andrew A Borkowski
- National Artificial Intelligence Institute, Washington, DC, USA; Artificial Intelligence Service, James A. Haley Veterans' Hospital, 13000 Bruce B Downs Boulevard, Tampa, FL 33647, USA; University of South Florida Morsani School of Medicine, Tampa, FL, USA
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3
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Fenton GA, Banfill G, Gera K, Seifert RP, Heldermon CD. Central nervous system nocardiosis mimicking recurrence of diffuse large B cell lymphoma with cerebral involvement. Int J Infect Dis 2023; 134:133-134. [PMID: 37302774 DOI: 10.1016/j.ijid.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/19/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023] Open
Affiliation(s)
- Graeme A Fenton
- College of Medicine, University of Florida, Gainesville, United States
| | - Grant Banfill
- College of Medicine, University of Florida, Gainesville, United States
| | - Kriti Gera
- Department of Medicine, University of Florida, Gainesville, United States.
| | - Robert P Seifert
- Department of Pathology, University of Florida, Gainesville, United States
| | - Coy D Heldermon
- Department of Medicine, Division of Hematology and Oncology, University of Florida, Gainesville, United States
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Guijarro MV, Nawab A, Dib P, Burkett S, Luo X, Feely M, Nasri E, Seifert RP, Kaye FJ, Zajac-Kaye M. TYMS promotes genomic instability and tumor progression in Ink4a/Arf null background. Oncogene 2023; 42:1926-1939. [PMID: 37106126 PMCID: PMC10244171 DOI: 10.1038/s41388-023-02694-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023]
Abstract
We previously showed that elevated TYMS exhibits oncogenic properties and promotes tumorigenesis after a long latency, suggesting cooperation with sequential somatic mutations. Here we report the cooperation of ectopic expression of human TYMS with loss of Ink4a/Arf, one of the most commonly mutated somatic events in human cancer. Using an hTS/Ink4a/Arf -/- genetically engineered mouse model we showed that deregulated TYMS expression in Ink4a/Arf null background accelerates tumorigenesis and metastasis. In addition, tumors from TYMS-expressing mice were associated with a phenotype of genomic instability including enhanced double strand DNA damage, aneuploidy and loss of G1/S checkpoint. Downregulation of TYMS in vitro decreased cell proliferation and sensitized tumor cells to antimetabolite chemotherapy. In addition, depletion of TYMS in vivo by TYMS shRNA reduced tumor incidence, delayed tumor progression and prolonged survival in hTS/Ink4a/Arf -/- mice. Our data shows that activation of TYMS in Ink4a/Arf null background enhances uncontrolled cell proliferation and tumor growth, supporting the development of new agents and strategies targeting TYMS to delay tumorigenesis and prolong survival.
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Affiliation(s)
- Maria V Guijarro
- Department of Anatomy and Cell Biology, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Akbar Nawab
- Department of Anatomy and Cell Biology, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Peter Dib
- Department of Anatomy and Cell Biology, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Sandra Burkett
- Molecular Cytogenetics Core Facility, CCR, National Cancer Institute, NIH, Frederick, MD, USA
| | - Xiaoping Luo
- Department of Anatomy and Cell Biology, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Michael Feely
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, 32608, USA
| | - Elham Nasri
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Robert P Seifert
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Frederic J Kaye
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Maria Zajac-Kaye
- Department of Anatomy and Cell Biology, University of Florida College of Medicine, Gainesville, FL, 32610, USA.
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5
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Guijarro MV, Kellish PC, Dib PE, Paciaroni NG, Nawab A, Andring J, Kulemina L, Borrero NV, Modenutti C, Feely M, Nasri E, Seifert RP, Luo X, Bennett RL, Shabashvili D, Licht JD, McKenna R, Roitberg A, Huigens RW, Kaye FJ, Zajac-Kaye M. First-in-class multifunctional TYMS nonclassical antifolate inhibitor with potent in vivo activity that prolongs survival. JCI Insight 2023; 8:e158798. [PMID: 37097751 PMCID: PMC10386886 DOI: 10.1172/jci.insight.158798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/18/2023] [Indexed: 04/26/2023] Open
Abstract
Although thymidylate synthase (TYMS) inhibitors have served as components of chemotherapy regimens, the currently available inhibitors induce TYMS overexpression or alter folate transport/metabolism feedback pathways that tumor cells exploit for drug resistance, limiting overall benefit. Here we report a small molecule TYMS inhibitor that i) exhibited enhanced antitumor activity as compared with current fluoropyrimidines and antifolates without inducing TYMS overexpression, ii) is structurally distinct from classical antifolates, iii) extended survival in both pancreatic xenograft tumor models and an hTS/Ink4a/Arf null genetically engineered mouse tumor model, and iv) is well tolerated with equal efficacy using either intraperitoneal or oral administration. Mechanistically, we verify the compound is a multifunctional nonclassical antifolate, and using a series of analogs, we identify structural features allowing direct TYMS inhibition while maintaining the ability to inhibit dihydrofolate reductase. Collectively, this work identifies nonclassical antifolate inhibitors that optimize inhibition of thymidylate biosynthesis with a favorable safety profile, highlighting the potential for enhanced cancer therapy.
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Affiliation(s)
| | | | | | | | | | - Jacob Andring
- Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, Florida, USA
| | | | | | - Carlos Modenutti
- Department of Biological Chemistry, Faculty of Exact and Natural Sciences, University of Buenos Aires, and
- Institute of Biological Chemistry of the Faculty of Exact and Natural Sciences (IQUIBICEN) CONICET, University City, Pab. II (CE1428EHA), Buenos Aires, Argentina
| | - Michael Feely
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Elham Nasri
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Robert P. Seifert
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Richard L. Bennett
- Department of Medicine, University of Florida Health Cancer Center, Gainesville, Florida, USA
| | | | - Jonathan D. Licht
- Department of Medicine, University of Florida Health Cancer Center, Gainesville, Florida, USA
| | - Robert McKenna
- Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, Florida, USA
| | - Adrian Roitberg
- Department of Chemistry, University of Florida, Gainesville, Florida, USA
| | | | - Frederic J. Kaye
- Department of Medicine, University of Florida Health Cancer Center, Gainesville, Florida, USA
| | - Maria Zajac-Kaye
- Department of Anatomy and Cell Biology
- Department of Medicine, University of Florida Health Cancer Center, Gainesville, Florida, USA
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6
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Hassell LA, Absar SF, Chauhan C, Dintzis S, Farver CF, Fathima S, Glassy EF, Goldstein JA, Gullapalli R, Ho J, Koch LK, Madory JE, Mirza KM, Nguyen PN, Pantanowitz L, Parwani A, Rojansky R, Seifert RP, Singh R, ElGabry EA, Bui M. Pathology Education Powered by Virtual and Digital Transformation: Now and the Future. Arch Pathol Lab Med 2023; 147:474-491. [PMID: 35878400 DOI: 10.5858/arpa.2021-0473-ra] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Myriad forces are changing teaching and learning strategies throughout all stages and types of pathology education. Pathology educators and learners face the challenge of adapting to and adopting new methods and tools. The digital pathology transformation and the associated educational ecosystem are major factors in this setting of change. OBJECTIVE.— To identify and collect resources, tools, and examples of educational innovations involving digital pathology that are valuable to pathology learners and teachers at each phase of professional development. DATA SOURCES.— Sources were a literature review and the personal experience of authors and educators. CONCLUSIONS.— High-quality digital pathology tools and resources have permeated all the major niches within anatomic pathology and are increasingly well applied to clinical pathology for learners at all levels. Coupled with other virtual tools, the training landscape in pathology is highly enriched and much more accessible than in the past. Digital pathology is well suited to the demands of peer-to-peer education, such as in the introduction of new testing, grading, or other standardized practices. We found that digital pathology was well adapted to apply our current understanding of optimal teaching strategies and was effective at the undergraduate, graduate, postgraduate, and peer-to-peer levels. We curated and tabulated many existing resources within some segments of pathology. We identified several best practices for each training or educational stage based on current materials and proposed high-priority areas for potential future development.
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Affiliation(s)
- Lewis A Hassell
- From the Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City (Hassell)
| | - Syeda Fatima Absar
- The Department of Pathology, Geisinger Medical Center, Danville, Pennsylvania (Absar)
| | - Chhavi Chauhan
- The American Society for Investigative Pathology, Cary, North Carolina (Chauhan)
| | - Suzanne Dintzis
- The Department of Laboratory Medicine and Pathology, University of Washington, Seattle (Dintzis, Koch)
| | - Carol F Farver
- The Department of Pathology (Farver), University of Michigan, Ann Arbor
| | - Samreen Fathima
- The Department of Pathology, Baylor University Medical Center, Dallas, Texas (Fathima)
| | - Eric F Glassy
- Affiliated Pathologists Medical Group, Palos Verdes Estates, California (Glassy)
| | - Jeffery A Goldstein
- the Department of Pathology, Northwestern University, Chicago, Illinois (Goldstein)
| | - Rama Gullapalli
- the Department of Pathology, University of New Mexico, Albuquerque (Gullapalli)
| | - Jonhan Ho
- The Department of Dermatopathology, University of Pittsburgh Medical Center, Washington, Pennsylvania (Ho)
| | - Lisa K Koch
- The Department of Laboratory Medicine and Pathology, University of Washington, Seattle (Dintzis, Koch)
| | - James E Madory
- The Department of Pathology, Medical University of South Carolina, Charleston (Madory)
| | - Kamran M Mirza
- The Department of Pathology and Laboratory Medicine, Loyola University Chicago Stritch School of Medicine, River Forest, Illinois (Mirza)
| | - Phuong Nhat Nguyen
- The Forensic Medicine Center of Ho Chi Minh City, Ho Chi Minh City, Vietnam (Nguyen)
| | - Liron Pantanowitz
- The Department of Pathology and Clinical Labs (Pantanowitz), University of Michigan, Ann Arbor
| | - Anil Parwani
- The Department of Anatomic Pathology, The Ohio State University, Columbus (Parwani)
| | - Rebecca Rojansky
- The Department of Pathology, Stanford University Hospital and Clinics, Stanford, California (Rojansky)
| | - Robert P Seifert
- The Department of Pathology, University of Florida, Gainesville (Seifert)
| | - Rajendra Singh
- The Department of Pathology, Norwell Health, Montville, New Jersey (Singh)
| | - Ehab A ElGabry
- the Department of Companion Diagnostics, Roche Tissue Diagnostics, Oro Valley, Arizona (ElGabry)
| | - Marilyn Bui
- and the Department of Interdisciplinary Oncology-Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Bui)
- ElGabry and Bui are co-senior authors
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7
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Muacevic A, Adler JR, Altshuler E, Seifert RP, Al-Mansour ZA. Pericardial Effusion: A Novel Presentation of Aplastic Anemia. Cureus 2023; 15:e33276. [PMID: 36741642 PMCID: PMC9894639 DOI: 10.7759/cureus.33276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/04/2023] Open
Abstract
Pericardial effusion is defined as the accumulation of fluid between the visceral and parietal pericardium. The underlying etiology varies as any pathology that causes pericarditis or involves the pericardium can cause effusion. In practice, the majority of pericarditis cases are idiopathic, although these are assumed to be secondary to occult viral infection or inflammatory phenomena. Malignancy, particularly the metastatic spread of noncardiac primary tumors, has been implicated as a differential in the diagnosis of pericardial effusion. Though commonly seen in solid malignancies, effusion has been reported in hematologic malignancies such as myelodysplastic syndrome (MDS), acute leukemia, and lymphoma. Nonetheless, pericardial effusions associated with hematologic conditions are extremely rare with only one case report published describing pericardial effusion secondary to immune thrombocytopenia (ITP). We herein report the first documented case, to our knowledge, of pericardial effusion as an initial clinical manifestation of aplastic anemia in a middle-aged male presenting with pancytopenia.
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8
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Weaver KD, De Los Santos Y, Gaffar M, Zona MC, Gennaro T, Shenoy A, Flax S, Chamala S, Seifert RP, Esnakula AK. Wrong Tissue in Block. Am J Clin Pathol 2021; 156:700-707. [PMID: 33940603 DOI: 10.1093/ajcp/aqab011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Maintaining specimen identity during surgical pathology tissue processing is critical. Epic Beaker Laboratory Information System requires sequential scanning of specimen label and grossed blocks (block confirmation) to ensure specimen identity. We report our institution's experience with wrong tissue in block (WTIB) grossing errors before and after adopting block confirmation. METHODS During the first 18 months of Beaker implementation, block confirmation was not required. We then mandated block confirmation for a 3-month period. To ensure compliance, we then built a "hard stop" feature that prevents scanning any unconfirmed blocks onto a packing list. We reviewed WTIB incidents pre- and postimplementation of these solutions. RESULTS Before using block confirmation, we had WTIB incidents involving 17 (0.043%) of 38,848 cases. When we mandated block confirmation use, we had WTIB involving 2 (0.043%) of 4,646 cases. After implementing the hard stop feature, we had WTIB incidents involving 2 (0.005%) of 42,411 cases. Overall, there was an 88.4% (0.043% vs 0.005%; P < .001) reduction in WTIB incidents using block confirmation with a hard stop. CONCLUSIONS Beaker is a customizable platform that can be tailored to a laboratory's workflow. By using barcoding, implementing custom-built features, and improving workflow protocols, we significantly reduced WTIB errors.
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Affiliation(s)
- Kaitlin D Weaver
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Yanel De Los Santos
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Maira Gaffar
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Melanie C Zona
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Tyler Gennaro
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Archana Shenoy
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Sherri Flax
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Srikar Chamala
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Robert P Seifert
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Ashwini K Esnakula
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
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Seifert RP, Casler V, Al Qaysi N, Gothi SR, Williams L, Christensen PR, Flax S, Chamala S. Informatics driven quality improvement in the modern histology lab. JAMIA Open 2020; 3:530-535. [PMID: 33623889 PMCID: PMC7886543 DOI: 10.1093/jamiaopen/ooaa066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/23/2020] [Indexed: 11/16/2022] Open
Abstract
Laboratory Information Systems (LIS) and data visualization techniques have untapped potential in anatomic pathology laboratories. Pre-built functionalities of LIS do not address all the needs of a modern histology laboratory. For instance, “Go live” is not the end of LIS customization, but just the beginning. After closely evaluating various histology lab workflows, we implemented several custom data analytics dashboards and additional LIS functionalities to monitor and address weaknesses. Herein, we present our experience in LIS and data-tracking solutions that improved trainee education, slide logistics, staffing/instrumentation lobbying, and task tracking. The latter was addressed through the creation of a novel “status board” akin to those seen in inpatient wards. These use-cases can benefit other histology laboratories.
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Affiliation(s)
- Robert P Seifert
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | - Vektra Casler
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | - Nada Al Qaysi
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | - Shaileshbhai Revabhai Gothi
- Department of Computer and Information Science and Engineering, University of Florida, Gainesville, Florida, USA
| | - Leah Williams
- UF Health Medical Laboratories, Gainesville, Florida, USA
| | | | - Sherri Flax
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | - Srikar Chamala
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
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10
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Iyer SSR, Jin Z, Seifert RP, Dang NH. Bilateral pseudohypopyon causing white eyes in a patient with lymphoma. Lancet 2020; 395:e74. [PMID: 32334711 DOI: 10.1016/s0140-6736(20)30610-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 02/12/2020] [Accepted: 03/06/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Siva S Radhakrishnan Iyer
- Department of Ophthalmology, University of Florida College of Medicine, University of Florida College of Medicine, Gainesville, FL, USA.
| | - Zhongbo Jin
- Department of Pathology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Robert P Seifert
- Department of Pathology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Nam H Dang
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
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11
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John S, Antonia SJ, Rose TA, Seifert RP, Centeno BA, Wagner AS, Creelan BC. Progressive hypoventilation due to mixed CD8 + and CD4 + lymphocytic polymyositis following tremelimumab - durvalumab treatment. J Immunother Cancer 2017; 5:54. [PMID: 28716137 PMCID: PMC5514517 DOI: 10.1186/s40425-017-0258-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 06/14/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The combination of CTLA-4 and PD-L1 inhibitors has a manageable adverse effect profile, although rare immune-related adverse events (irAE) can occur. CASE PRESENTATION We describe an autoimmune polymyositis following a partial response to combination tremelimumab and durvalumab for the treatment of recurrent lung adenocarcinoma. Radiography revealed significant reduction in all metastases; however, the patient developed progressive neuromuscular hypoventilation due to lymphocytic destruction of the diaphragmatic musculature. Serologic testing revealed a low level of de novo circulating antibodies against striated muscle fiber. Immunohistochemistry revealed type II muscle fiber atrophy with a mixed CD8+ and CD4+ lymphocyte infiltrate, indicative of inflammatory myopathy. CONCLUSIONS This case supports the hypothesis that muscle tissue is a target for lymphocytic infiltration in immune checkpoint inhibitor-associated polymyositis. Further insights into the autoimmune mechanism of PM will hopefully contribute to the prevention and treatment of this phenomenon.
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Affiliation(s)
- Sooraj John
- Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612 USA
| | - Scott J. Antonia
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL 33612 USA
| | - Trevor A. Rose
- Department of Diagnostic Radiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL 33612 USA
| | - Robert P. Seifert
- Department of Pathology and Cell Biology, University of South Florida, 12901 Bruce B. Downs Blvd., MDC 11, Tampa, FL 33612 USA
| | - Barbara A. Centeno
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL 33612 USA
| | - Aaron S. Wagner
- Orlando Health Pathology, 1414 Kuhl Ave., MP 44, Orlando, FL 32806 USA
| | - Ben C. Creelan
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612 USA
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Seifert RP, McNab P, Sexton WJ, Sawczyn KK, Smith P, Coppola D, Bui MM. Rhabdomyomatous differentiation in Wilms tumor pulmonary metastases: a case report and literature review. Ann Clin Lab Sci 2012; 42:409-416. [PMID: 23090738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
While sparsely reported in the literature, Wilms tumor may differentiate into more mature mesenchymal tissue types, such as skeletal muscle, following chemotherapy. The frequency of this event is unknown. Chemotherapy and radiation may induce cytodifferentiation of Wilms tumor cells or select for the survival of less mitotically active cells. In follow-up biopsies, the presence of rhabdomyomatous differentiation can confound the histologic diagnosis. Furthermore, these differentiated tumors appear to be more resistant to chemotherapy, thus biopsy and positron emission tomography scans following chemotherapy and radiation may prevent unnecessary treatment. We report an unusual case of Wilms tumor in a 21- year-old man with rhabdomyomatous differentiation of pulmonary metastases after chemotherapy, which presented a challenge during frozen section diagnosis.
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